动脉血乳酸清除率与老年COPD合并呼吸衰竭患者预后的相关性

目的 探讨动脉血乳酸清除率(LCR)与老年COPD并呼吸衰竭患者预后的关系.方法 选取98例老年COPD并Ⅱ型呼吸衰竭患者进行回顾性研究,根据患者的病情转归分为存活组74例、死亡组24例,对比2组患者的机械通气治疗早期(6h以内)的LCR等指标并进行分析.结果 存活组的机械通气治疗6h以内的APACHEⅡ、PaCO2值均显著低于死亡组,差异有统计学意义(t=8.337、13.983,P＜0.05).存活组的机械通气治疗6h以内的LCR、pH值、PaO2、PaO2/FiO2值均显著高于死亡组,差异有统计学意义(t=16.920、7.487、8.825、4.828,P＜0.05).经过Logistic回归分析,LCR是COPD合并呼吸衰竭患者预后的保护因素(OR=0.404,P＜0.05),APACHEⅡ是COPD合并呼吸衰竭患者预后的危险因素(OR=1.392,P＜0.05).动脉血LCR预测老年COPD并呼吸衰竭患者死亡的灵敏度为83.04％、特异度为86.92％,临界值为10.00％,ROC曲线下面积为0.861.结论 监测老年COPD并呼吸衰竭患者的动脉血LCR对于评估患者的预后具有一定的临床价值.

Correlation between arterial blood LCR and prognosis of elderly patients with COPD complicated with respiratory failure

Objective To investigate the relationship between arterial blood lactate clearance rate (LCR) and prognosis in elderly patients with chronic obstructive pulmonary disease (COPD) and respiratory failure.Methods Ninety-eight cases of elderly patients with COPD and respiratory failure were studied retrospectively,according to the patients' condition,74 cases were survival group,24 cases were death group,comparison of the LCR in early (less than 6 hours) with mechanical ventilation in two groups.Results Survival within the mechanical ventilation in the treatment group 6 h APACHE Ⅱ,PaCO2 values were significantly lower than the death group,the difference was statistically significant (t =8.337,13.983,P ＜0.05).Survival within the mechanical ventilation in the treatment o1f group 6 h,LCR,pH,PaO2 values and PaO2/FiO2 values were significantly higher than the death group,the difference has statistical significance (t =16.920,7.487,8.825,4.828,P ＜0.05).After Logistic regression analysis,LCR is a protective factor for the prognosis of COPD patients with respiratory failure (OR =0.404,P ＜ 0.05),APACHE Ⅱ is a risk factor for the prognosis of COPD patients with respiratory failure (OR =1.392,P ＜ 0.05).Arterial blood LCR prediction in elderly COPD respiratory failure patients death sensitivity was 83.04％,specificity was 86.92％,the critical value for 10 ％,ROC area under the curve was 0.861.Conclusions Monitoring the arterial blood LCR in elderly patients with COPD and respiratory failure has a certain clinical value in evaluating the prognosis of the patients.